Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group(n = 30), patients received oral sulfasalazine treatment; experimental group(n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8(IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group(P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant(χ~2 = 33.215, P = 0.000).CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.

Differential diagnosis in ulcerative colitis in an adolescent: Chronic granulomatous disease needs extra attention

Chronic granulomatous disease(CGD) is a primary immune deficiency that is commonly diagnosed under the age of 5 years(95%) and is rarely seen in adulthood. CGD may manifest as inflammatory bowel disease(IBD) in childhood. Without proper diagnosis, these patients may be monitored for years as IBD; some may even be regarded as steroid-resistant ulcerative colitis(UC) and end up having a colectomy. In this case report, we described a patient who had been followedup for years as UC and subsequently underwent colectomy, but was finally diagnosed in adulthood as primary immune deficiency.

In-vivo characterization of DALM in ulcerative colitis with high-resolution probe-based confocal laser endomicroscopy

Recently,the use of confocal laser endomicroscopy(CLE) in the diagnosis of chronic ulcerative colitis(CUC) was reported.In this brief report we aimed to assess the application of probe-based CLE to characterize colonic mucosa and dysplasia in CUC.The study involved a patient presenting long-standing CUC.Confocal imaging of both the inflamed mucosa,a circumscribed lesion(dysplasiaassociated lesional mass),and adjacent colonic mucosa are demonstrated and the correlation between the CLE and histological images.Inflamed mucosa and dysplasia showed specific alteration of crypt architecture,cellular infiltration,and vessel architecture with an excellent correlation between CLE and standard histological examination.

Opioid use and misuse in ulcerative colitis

BACKGROUND Patients with ulcerative colitis(UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders(FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn's disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.AIM To evaluate the prevalence of chronic opioid use and misuse in UC.METHODS A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.RESULTS A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically(36% with FGID vs 9% without FGID, P < 0.0001)and were misusing prescription opioids(12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use(OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse(OR = 5.19; 95%CI1.04-25.76). Tobacco use(OR 2.53; 95%CI: 1.06-6.08) and anxiety(OR 3.17; 95%CI:1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.CONCLUSION FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.

Infliximab does not increase colonic cancer risk associated to murine chronic colitis

AIM To explore the influence of Infliximab(IFX) on cancer progression in a murine model of colonic cancer associated to chronic colitis.METHODS AOM/DSS model was induced in C57BL/6 mice. Mice were injected with IFX(5 mg/kg) during each DSS cycle while control mice received saline. Body weight, occult blood test and stool consistency were measured to calculate the disease activity index(DAI). Mice were sacrificed at week 10 and colons were analyzed macroscopically and microscopically for number of cancers and degree of inflammation. MTT assay was performed on CT26 to evaluate the potential IFX role on metabolic activity and proliferation. Cells were incubated with TNF-α or IFX or TNF-α plus IFX, and cell vitality was evaluated after 6, 24 and 48 h. The same setting was used after pre-incubation with TNF-α for 24 h.RESULTS IFX significantly reduced DAI and body weight loss in mice compared with controls, preserving also colon length at sacrifice. Histological score was also reduced in treated mice. At macroscopic analysis, IFX treated mice showed a lower number of tumor lesions compared to controls. This was confirmed at microscopic analysis, although differences were not statistically significant. In vitro, IFX treated CT26 maintained similar proliferation ability at MTT test, both when exposed to IFX alone and when associated to TNF-α.CONCLUSION IFX did not increase colonic cancer risk in AOM-DSS model of cancer on chronic colitis nor influence directly the proliferation of murine colon cancer epithelial cells.

以痈论治溃疡性结肠炎理论阐释及临床思路探析

于永铎认为,痈为火毒生,下利脓血为热毒本质,提出“病由毒起,热毒伤肠”为溃疡性结肠炎病机关键,“邪踞火毒”“湿热毒邪”“正虚伏毒”为溃疡性结肠炎的核心病机演变规律,体现热毒伤肠络,毒邪由实致虚,虚实夹杂的病邪转变过程。结合从肠黏膜屏障损伤、免疫功能紊乱、细胞自噬、凋亡、焦亡的病变特点及交叉转化的因果联系,提出以痈论治溃疡性结肠炎的核心治法,采用清热解毒、凉血消痈,清热利湿、解毒消痈,健脾益气、托毒消痈等辨治策略,并结合临床验案进行分析,以期为溃疡性结肠炎的治疗提供参考。

Clinical outcome of ileal pouch-anal anastomosis for chronic ulcerative colitis in China

Background The incidence of chronic ulcerative colitis （CUC） in China is remarkably increasing, while little information on surgical treatment has been reported. This study aimed to completely describe and analyze the clinical outcome of restorative proctocolectomy with ileal pouch-anal anastomosis （IPAA）for CUC in China. Methods Ninety-five consecutive patients, who suffered CUC and had surgical indications, were carefully selected. All patients underwent IPAA. Data on patient characteristics, surgical indications, surgical details, postoperative complications, functional outcome, and quality of life were collected. Results The mean patient age at the time of the operation was 32 years. Twenty-nine （31%） patients underwent an emergency operation, and 66 （69%） underwent elective procedures. Four patients with severe dysplasia underwent operations, but no carcinoma was histologically confirmed. A two-stage operation was performed in 87 （92%） patients, and a hand-sewn technique was applied in 88 （93%） patients. Sixteen patients （17.0%） experienced early complications, and there was a significant difference between the emergency surgery group and the elective group （31.0% vs. 10.6%, respectively; P 〈0.01）. Five （5.3%） patients developed pouchitis as a late complication. The mean stool frequency after the operation was 4.6 （2-11） during the first 24 hours and 1.5 （0-4） overnight. According to the Kirwan grading scale, 87 （91.8%） patients showed satisfactory anal continence function. The quality of life improved significantly from a preoperative mean value of 0.28-0.61 before ileostomy closure to 0.78 after ileostomy closure （P 〈0.01） according to the Cleveland Global Quality of Life index. Conclusions IPAA is an effective and safe surgical procedure for patients with CUC in China. However, some characteristics, such as the low incidence of pouchitis, require further study.

从厥阴病机论乌梅丸现代临床证治思路

从厥阴病寒热错杂,阴阳失和的病机入手,探析乌梅丸收敛气血,调和阴阳的作用及其临床应用范围。结合现代药理学研究及古今医家经验,总结出乌梅丸在治疗糖尿病性胃轻瘫、胃食管反流病、慢性顽固性腹泻、慢性胆囊炎、顽固性失眠和溃疡性结肠炎上所取得的显著疗效,为经方临床应用提供思路。

Ulcerative colitis triggered by pegylated interferon alpha-2b in a patient with chronic hepatitis B: A case report and literature review

Interferon(IFN)is a multifaceted immunomodulator that is effective against many diseases,including chronic hepatitis B and chronic hepatitis C infection.IFN defends against viral infection,but may also cause various side effects,such as ulcerative colitis(UC).Herein,we present a case of UC triggered by pegylated interferon alpha-2b(PEG-IFN-α-2b)therapy in a patient with concurrent chronic hepatitis B(CHB)infection.The diagnosis was based on typical clinical symptoms,colonoscopy findings,colonic mucosal biopsy,and histopathology.Accordingly,treatment with mesalazine was initiated without stopping PEG-IFN-α-2b.Fortunately,UC relieved gradually without compromising the effects of treatment.Simultaneously,we conducted a literature review of previously published case reports on the side effect of UC in patients with underlying chronic hepatitis.Various reactions have been reported,including induction,exacerbation,and no change.This is the first report of UC triggered by PEG-IFN-α-2b in a CHB patient.We recommend that physicians pay attention to the rare side effect of UC during administration of PEG-IFN-α-2b.Mesalazine can relieve UC with sustained use of PEG-IFN-α-2b.

逆流挽舟法论治溃疡性结肠炎

溃疡性结肠炎是一种常见疾病,但因其病程迁延难愈且病机仍未明确而被世界卫生组织列为难治性疾病之一。溃疡性结肠炎可对患者身心及生活造成较大影响。目前西医治疗主要以药物消炎、缓解症状等为主,但均不宜长久使用。清代喻嘉言创立的“逆流挽舟”治法对改善溃疡性结肠炎症状有明显效果,但现代临床使用较少,故笔者对“逆流挽舟”法的起源思想及其作用机制作一论述,以期为临床医师提供更多溃疡性结肠炎中医辨证论治思路。

慢性溃疡性结肠炎小鼠疾病活动度、组织病理及细胞因子动态变化分析

目的 分析慢性溃疡性结肠炎(ulcerative colitis, UC)小鼠疾病活动度、结肠炎症和组织病理及血清细胞因子水平的动态变化。方法 2.5%葡聚糖硫酸钠(诱导)+饮用水(缓解)各5 d自由饮用为1个周期,重复3个周期。记录疾病活动指数、结肠长度及组织病理损伤等,检测结肠髓过氧化物酶(myeloperoxidase, MPO)、血清和结肠IL-1β等细胞因子含量。结果 在3个周期中,小鼠疾病活动度和结肠长度缩短现象在诱导期加重、缓解期减轻。第2和3周期便血时间提前,便血小鼠数量增多,体重短暂低幅度降低后迅速回升。第1和3周期结肠组织病理损伤程度和MPO含量在诱导期升高、缓解期降低,升降幅度低于DAI值变化幅度;在第2周期缓解期升高。在诱导中,脾指数、血清IL-1β、IL-6和IL-17A含量持续升高,实验结束时均高于正常组;TNF-α水平在诱导期升高、缓解期降低,IL-10变化趋势与TNF-α相似;TGF-β含量先升高后降低,第3周期结束后高于正常组。结肠IL-6、IL-1β和IL-17A的含量呈现相似的先升高后降低趋势;TNF-α含量无明显变化;IL-10含量在诱导期降低、缓解期升高。结论 在慢性UC诱导过程中,小鼠便血症状和全身性炎症反应逐渐加重,在死亡率、体重和结肠组织病理学损伤表现出逐渐增强的耐受力和恢复能力,结肠组织病理学损伤的发生和缓解滞后于症状变化,结肠炎症逐渐转变为以PMN活化为主的模式。

基于慢性疾病轨迹模式的护理干预在溃疡性结肠炎病人中的应用

目的:探讨基于慢性疾病轨迹模式的护理干预在溃疡性结肠炎病人中的应用效果。方法:选取溃疡性结肠炎病人86例,按照抽签法分为观察组(采用基于慢性疾病轨迹模式的护理干预)和对照组(常规护理干预),各43例。比较2组干预前后健康促进生活方式和症状困扰程度差异。结果:干预前和出院当天,2组病人一般活动、工作、情绪、人际关系、走路、兴趣的症状困扰率差异均无统计学意义(P>0.05),症状困扰程度差异亦无统计学意义(P>0.05);出院4周,观察组一般活动、工作、情绪、兴趣的症状困扰率均低于对照组(P<0.05),症状困扰程度明显优于对照组(P<0.01)。干预前,2组病人健康促进生活方式各维度差异均无统计学意义(P>0.05);出院当天和出院4周,观察组各维度得分均高于对照组(P<0.05~P<0.01)。结论:基于慢性疾病轨迹模式的护理干预有助于降低病人症状困扰率和困扰程度,提高病人健康促进生活方式。

补脾益肠丸联合柳氮磺吡啶治疗慢性溃疡性结肠炎临床研究

目的:观察补脾益肠丸联合柳氮磺吡啶治疗慢性溃疡性结肠炎的临床疗效。方法:采用随机数字抽签法将90例慢性溃疡性结肠炎患者分为对照组与观察组各45例。对照组采用柳氮磺吡啶治疗,观察组采用补脾益肠丸联合柳氮磺吡啶治疗,2组连续用药30 d。比较2组治疗前后中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、基质金属蛋白酶-9(MMP-9)、炎症因子[C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平;比较2组中医证候积分、肠黏膜病变评分、Mayo活动指数评分,评估2组临床疗效及不良反应发生情况。结果:观察组治疗总有效率97.78%,高于对照组82.22%(P<0.05)。2组治疗后中医证候积分、肠黏膜病变评分、Mayo活动指数评分均较治疗前降低(P<0.05),且观察组治疗后上述指标均低于对照组(P<0.05)。2组治疗后NGAL、MMP-9、CRP、TNF-α、IL-6水平均较治疗前降低(P<0.05),且观察组治疗后炎症因子及NGAL、MMP-9水平均低于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:补脾益肠丸联合柳氮磺吡啶治疗慢性溃疡性结肠炎疗效确切,能显著改善患者临床症状,降低炎症因子水平,安全性较高。

中药辨证治疗慢性溃疡性结肠炎的效果

目的本文通过将常规西药治疗、西药联合中药辨证治疗两种方式治疗后患者的症状改善情况和安全性进行比较,来探讨和分析两种治疗方式的实际应用效果。方法选取2020年6月—2021年6月本院收治的60例慢性溃疡性结肠炎患者为研究对象,采用抽签的方式分为对照组和观察组,每组30例。其中,对照组采用常规西药治疗,观察组在对照组的基础上联合中药辨证治疗,比较两组治疗效果。结果观察组临床治疗总有效率高于对照组,组间差异有统计学意义(P<0.05)。治疗前,组间各项症状积分相比,差异无统计学意义(P>0.05);治疗后,两组各项中医证候积分均有所降低,且观察组更低,组间差异有统计学意义(P<0.05)。两组患者在治疗期间不良事件的发生率相比,差异无统计学意义(P>0.05)。结论在慢性溃疡性结肠炎患者的治疗过程中,相较于单独依赖西药治疗的传统方法,结合中医的辨证施治理念进行联合治疗,能够更为显著地减轻患者的临床症状,同时不会增加患者的生理负担,确保治疗过程的安全性。此举展现出较高的临床实用价值,值得在临床实践中进一步推广与应用。

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

Antimicrobial peptide LL-37 forms complex with bacterial DNA to facilitate blood translocation of bacterial DNA and aggravate ulcerative colitis

Bacterial DNA(bacDNA) is frequently found in serum of patient with ulcerative colitis(UC) and Crohn's disease, even blood bacterial culture is negative. How bacDNA evades immune elimination and is translocated into blood remain unclear. Here, we showed that bacDNA avoids elimination and disables bacteriakilling function of antimicrobial peptide LL-37(Cramp in mice) by forming complex with LL-37, which is inducible after culture with bacteria or bacterial products. Elevated LL-37-bacDNA complex was found in plasma and lesions of patients with UC. LL-37-bacDNA promoted inflammation by inducing Th1, Th2 and Th17 differentiation and activating toll-like receptor-9(TLR9). The complex also increased paracellular permeability, which possibly combines its inflammatory effects to promote local damage and bacDNA translocation into blood. Cramp-bacDNA aggravated mouse colitis severity while interference with the complex ameliorated the disease. The study identifies that inflammatogenic bacDNA utilizes LL-37 as a vehicle for blood translocation and to evade immune elimination. Additionally, bacteria may make a milieu by releasing bacDNA to utilize and resist host antimicrobial peptides as a ‘trojan horse'.

Atherosclerotic cardiovascular disease in inflammatory bowel disease:The role of chronic inflammation

Inflammatory bowel disease(IBD)causes systemic vascular inflammation.The increased risk of venous as well as arterial thromboembolic phenomena in IBD is well established.More recently,a relationship between IBD and atherosclerotic cardiovascular disease(ASCVD)has been postulated.Systemic inflammatory diseases,such as rheumatoid arthritis and systemic lupus erythematosus,have well characterized cardiac pathologies and treatments that focus on prevention of disease associated ASCVD.The impact of chronic inflammation on ASCVD in IBD remains poorly characterized.This manuscript aims to review and summarize the current literature pertaining to IBD and ASCVD with respect to its pathophysiology and impact of medications in order to encourage further research that can improve understanding and help develop clinical recommendations for prevention and management of ASCVD in patients with IBD.

健脾益气化瘀汤辅助治疗慢性复发型溃疡性结肠炎的效果

目的探讨健脾益气化瘀汤辅助治疗慢性复发型溃疡性结肠炎的效果。方法选取2019年4月至2021年4月本院收治的100例慢性复发型溃疡性结肠炎患者作为研究对象,按照随机数字表法分为对照组与研究组,各50例。对照组采用美沙拉嗪治疗,研究组在对照组基础上采用健脾益气化瘀汤辅助治疗,比较两组治疗效果、抗氧化与炎症指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、白细胞介素(IL)-17、IL-23]及复发情况。结果治疗前,两组腹泻、腹痛、黏液脓血便评分比较差异无统计学意义;治疗后,两组腹泻、腹痛、黏液脓血便评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组MDA、IL-17、IL-23、SOD水平比较差异无统计学意义;治疗后,两组MDA、IL-17、IL-23水平均低于治疗前,SOD水平均高于治疗前,且观察组MDA、IL-17、IL-23水平均低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05)。两组复发率比较差异无统计学意义。结论健脾益气化瘀汤辅助治疗慢性复发型溃疡性结肠炎的效果显著,能明显提高患者抗氧化能力,从而减轻炎症反应,值得临床推广应用。

穴位敷贴联合精细化护理干预慢性非特异性溃疡性结肠炎患者的疗效观察

目的研究穴位敷贴联合精细化护理干预慢性非特异性溃疡性结肠炎患者的效果。方法选取2021年1月至2022年12月于湖南中医药大学第一附属医院肛肠科住院的慢性非特异性溃疡性结肠炎患者98例,采用随机数字表法分为对照组和观察组,每组49例。两组患者均采取中西医结合治疗,在此基础上,对照组采取常规护理,观察组予以穴位敷贴联合精细化护理。两组均干预10 d,比较两组的临床疗效、护理满意度、血清炎症因子水平、自我护理能力及生活质量。结果干预后,观察组临床总有效率高于对照组(P<0.01),观察组满意度高于对照组(P<0.05);干预后,两组患者TNF-α、IL-6水平均低于干预前(P<0.01),且观察组TNF-α、IL-6水平低于对照组(P<0.01);干预后,两组患者ESCA量表评分、GQOL-74量表评分均高于干预前(P<0.01),且观察组ESCA量表评分、GQOL-74量表评分均高于对照组(P<0.01)。结论穴位敷贴联合精细化护理优于常规护理,有助于提高慢性非特异性溃疡性结肠炎患者治疗效果,可下调炎症因子水平,提高患者的自护能力、生活质量及满意度,有利于患者的康复。